PB1907: EPIDEMIOLOGICAL PROFILE AND DIAGNOSTIC FEATURES OF ACUTE MYELOBLASTIC LEUKEMIA IN ADULTS: EXPERIENCE OF THE HEMATOLOGY DEPARTMENT OF SFAX
Authors: Nour Siala, Yousra Fakhfakh Derbel, Imen Ben Amor, Mourad Chaari, Olfa Kassar, Ines Jdidi, Imen Frikha, Nour Louati, Faten Kallel, Maha Charfi, Hlima Sannena, Samia Mnif, Khelifa Latifa, Rahma Mallek, Sondes Hadiji Mseddi, Moez Medhaffar, Ali Saad, Ikram Ben Amor, Choumous Kallel, Moez Elloumi
Journal: HemaSphere (2023)

Topic: 4. Acute myeloid leukemia - Clinical Background: Acute myeloid leukemia (AML) is a group of malignant hemopathies genetically and phenotypically very heterogeneous. Identification of clinical and biological prognostic factors is essential for better prognostic stratification and therefore a better adaptation of the treatment. Aims: We aim to analyze the epidemiologic characteristics and diagnostic aspects of adult AML in southern Tunisia. Methods: Our study is retrospective. We included newly adult AML patients (age: 20-60 years) diagnosed and treated in the hematology department of CHU Hedi Chaker Sfax, between January 2005 and December 2020. Diagnosis has been established according to FAB classification confirmed by flow cytometry (FC). Patients with acute promyelocytic or secondary leukemia were excluded. The classification of AML into three risk groups was based on the Medical Research Council (MRC) stratification. The molecular study is realized by the RT-PCR method in order to search for mutations with a prognostic impact (CBF-Myh11, AML-ETO, FLT3). we report the demographic and epidemiological characteristics of patients, and we analyze the clinical and biological features of AML in southern Tunisia. Results: We collected 179 cases of adult AML, including 97 boys and 82 girls (sex ratio=1.18). The median age at diagnosis was 40 years (range: 20 to 59 years). The mean time to diagnosis was 23 days (extreme: 3-65 days). Clinically, the anemic syndrome was found in 154 patients (86%), an infectious syndrome in 108 patients (60%), and a hemorrhagic syndrome in 62 patients (35%). The tumor syndrome had been noted in 88 patients (49%). The median initial white blood cell and hemoglobin level was 13.6 G/L (extreme 4 G/L- 470 G/L) and 7.2g/dL (extreme:2.1g/dL-14.2g/dL) respectively. The median count of platelet was 40 G/L (extreme: 4 G/L -697 G/L) and severe thrombopenia (platelet < 50 G/L) was noted in 102 cases (57%). The most common cytological type was AML2 (24%) followed by AML4 (21%). Cytogenetic analysis was done for 98% of patients, while it was not feasible in 4 cases because of the SARS-COV pandemic. The oncological karyotype was normal in 46% of cases. Only 32 (18%) patients had favorable abnormalities [t (8.21) in 32 cases and 16inv in 9 cases]. Karyotype was complex in 12 cases (7%). The distribution of our patients according to the cytogenetic risk group was as follows: low-risk abnormalities in 18%, intermediate-risk in 69%, and high-risk in 13% of cases. The molecular study was feasible only for 91 patients, concluding to CBF-myh11, AML-ETO, and FLT3 in 15%, 11%, and 1% respectively. Summary/Conclusion: The clinical and demographic characteristics of our patients differ from those reported in the literature only by the median age which seems younger in relation to the inclusion criteria. The cytogenetic profile of our AML is characterized by the dominance of the normal karyotype which is comparable to the literature (46% in our series vs more than 40% in the literature) making the inclusion of the majority of our patients in the risk group intermediate (69%). More investigations in terms of molecular biology (made only in half of our cases) could be beneficial to better classify our patients to further adapt the treatment of each risk group. Keywords: Acute leukemia, Acute myeloid leukemia